Diep, Jack

Diep, Jack is an individual health care provider with primary practice located at 1791 Mesquite Ave , Lake Havasu City AZ 86403-5648. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Pain Medicine, Allopathic & Osteopathic Physicians / Interventional Pain Medicine. Allopathic & Osteopathic Physicians / Interventional Pain Medicine is his primary health care specialty. Diep, Jack can be contacted via phone (928) 505-5555.

Contact Information

Primary practice address
1791 Mesquite Ave Lake Havasu City AZ 86403-5648
Phone: (928) 505-5555
Fax: (928) 505-2877
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pain Medicine 207LP2900X 55528 Arizona
Allopathic & Osteopathic Physicians / Pain Medicine 208VP0000X 55528 Arizona
Allopathic & Osteopathic Physicians / Interventional Pain Medicine 208VP0014X 55528 Arizona

Profile Details

NPI number 1912333014
LBN Legal business name Diep, Jack
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 20th, 2013
Last updated Sep 27th, 2022 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1912333014 NPPES
Arizona MEDICAID 369607

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